Get Mnsure Account Request Form

Filling out the MNsure Account Request Form is an essential step for creating your online account. This guide provides clear instructions to help you navigate the process smoothly and ensure all required information is accurately submitted.

Follow the steps to complete your MNsure Account Request Form.

1. Click the ‘Get Form’ button to download the MNsure Account Request Form and open it in your chosen document editor.
2. In the first section labeled 'Person requesting a MNsure account', fill in your first name, middle name, and last name. Make sure to enter your date of birth accurately.
3. Provide your street address, city, state, and zip code in the designated fields. This information is crucial for verifying your identity.
4. Enter your phone number and email address. Make sure these are correct, as this information may be used for follow-up communication.
5. If you are working with a MNsure Community Assistance Partner, provide their name and email address where indicated, authorizing them to access your credentials.
6. Select one identity document that you will attach to this form. Options include a current driver’s license, military identification card, school identification card, and others listed in the form. Remember to only submit copies of these documents.
7. If you cannot attach any of the selected documents, provide two alternate documents as mentioned in the form, such as a birth certificate or Social Security card.
8. Read the certification statement carefully. By signing the form, you agree that the information provided is accurate, and you understand the implications of submitting false information.
9. Sign and date the form in the designated signature area to validate your submission.
10. Finally, mail the completed form along with any attached identity documents to the address specified: MNsure Account Creation, 81 Seventh Street East, Suite 300, St. Paul, MN 55101-2444.

Complete your MNsure Account Request Form online today to access your benefits.